Emergency Management Midterm Exam

Emergency Operations Plan (EOP)

Should be a living document, flexible, and routinely updated and with backup plans; purpose is to provide an all hazards approach to emergency mgmt to eliminate or minimize the disruptions that affect a facility's ability to provide care and support to clients; contents include: crisis staffing, surge capacity, emergency phone system, child care, etc.

After-action review (AAR)

Should be conducted immediately after an incident, even if you are exhausted; take time to evaluate your plan, figure out what worked and what didn't and make adjustments

National Fire Protection Association 1600

Standard on disaster, emergency management, and business continuity and continuity of operations programs that contains requirements for the development, implementation, assessment, and maintenance of programs for prevention, mitigation, preparedness, response, continuity, and recovery

National Fire Protection Association 1561

Standards on emergency services incident management system and command safety; includes requirements for emergency services oriented toward ensuring the safety of emergency responders and others during an incident

National preparedness guidelines and strategy

States four major goals to focus on: 1) Prevent and disrupt terrorist attacks, 2) Protect the American people, our critical infrastructure, and key resources, 3) Respond to and recover from incidents, 4) Continue to strengthen the emergency-preparedness foundation

Hospital Incident Management Team (HIMT)

Structure depicts HICS functions with identified roles for how responsibilities are distributed among the assigned team members (command, finance and administration, logistics, operations, planning); there should always be a "3-deep" succession plan for key roles

Recovery

Takes place after an emergency; one of 5 National Preparedness Goal mission areas; involves focusing on timely restoration, strengthening and revitalization of infrastructure, housing, and sustainable economy, as well as the health, social, cultural, historic, and environmental fabric of communities affected by a catastrophic incident; can take weeks, months, and sometimes years

Mitigation

Takes place before and after emergencies; one of 5 National Preparedness Goal mission areas; includes any activities that prevent an emergency, reduce the chance an emergency will happen, or reduce the damaging effects of unavoidable emergencies

56

The # of times the Stafford Act is used on average

Phases of the media

The three reactions include: 1) Stunned by tragedy 2) Accusation (shortly after the shock, the hunt for someone to blame begins) 3) The story behind the news or the search for controversy (what really happened and why)

Costliest catastrophes in U.S. history

The top 10 into three general categories: 1) Earthquake, 2) Hurricane, 3) Terrorist attack

Rosy assumptions from hospitals made about disasters

These tend to not be true in a disaster: 1) There will be an equal distribution of casualties, 2) Casualties will arrive uncontaminated, 3) Casualties will all be brought in by ambulance with ample radio warning, 4) There will be prompt and comprehensive community services if the hospitals need it

Interactions between public health and emergency management

They used to be rare; closer alignment started in the 70s when the field of emergency management began to shift away from its orientation toward civil defense (typically focused on nuclear attacks) and more toward a greater range of natural and human-caused accidents; the wider range of interests came to be called "all hazards"; 9/11 strengthened ties

Main focus of public health departments

To protect communities in both manmade and natural disasters beyond just infectious diseases

Types of disaster declarations

Two types include: 1) Presidential declaration of disaster under Stafford Act which requires a formal request by a state governor, 2) Public Health Emergency declaration which the HHS secretary can declare without a formal request

National Response Framework

Works by 1) Setting out the roles and responsibilities of key implementers at the local, tribal, state, and federal levels, 2) Provides roles of private sector and NGOs, 3) Provides objectives of preserving the lives and social welfare and protecting the property of a defined population, 4) Helping to define mitigation, preparation, response, and recovery

Public Health Accreditation Board

32 standards linked to the 10 essential public health services for use by agencies seeking public health accreditation (e.g., requirements for emergency plans, policies, procedures, training, exercises, 24/7 operations, surge staffing, etc.)

National Public Health Performance Standards

40 standards linked to 10 essential public health services, devoted to driving improvement at a public health system level with additional content related to legal authority in emergencies

Emergency

A common, routine adverse event that is handled well by the local emergency medical services system; impact is limited to the affected individual or family; causes no disruption to the social order or psyche of the community or population; ex. broken bone, heart attack, stroke

400

Average # of disasters with damage per year in the U.S.

Protection Federal Interagency Operational Plan (FIOP)

Describes how the federal departments and agencies work together to deliver Protection core capabilities through eight coordinating activities; enable the federal government to execute the critical tasks associated with each core capability

Pandemic and All-Hazards Preparedness Act of 2006

Designates the Secretary of the Department of Health and Human Services as the lead for all federal public health and medical responses to public health emergencies covered by the National Response Plan

Logistics section chief

Leader in an incident responsible for: providing communication for planning and establishing resources, setting up and maintaining incident facilities, managing food services, all support needs of the incident, and acquiring resources from internal and external sources; wears a yellow vest

Order of response to an incident

Local > adjacent city or county > region > state > federal

HICS command staff

Maintains the overall management of an incident through setting incident objectives, strategies, and response priority; leader wears white vest; team includes liaison officer, safety officer, public information officer, medical/technical specialists

Narcissistic leader

One of the three common aberrant personalities; self-centered, egocentric, self-absorbed; seeks constant reassurance of his self-worth; primary leader is to himself; seek advisors who prop up their self-esteem; believe they are principled and scrupulous individuals

President

Role is to lead the federal government response through the Homeland Security Council and National Security Council; receives national strategic and policy advice from cabinet officers and other dept agency heads; can issue a formal declaration of a disaster to access federal resources and federal disaster reimbursement mechanisms

9 key domains of public health emergency management

1) Facilities, management, and operations 2) Policies, plans, procedures, and partnerships 3) Internal communications and IT 4) Crisis and emergency risk communication and public info and warning 5) Surveillance and control 6) Info collection, integration, and sharing 7) Incident mgmt and response 8) Coordination and logistics support of field operations 9) Training, exercising, and evaluation

Public Health Preparedness Capabilities: National Standards for State and Local Planning

15 capabilities related to tasks that state and local health departments are expected to be able to do based upon the resources they are expected to have

Emergency management cycle

A heuristic to understand between public health and emergency management- lately found increasing applicability to public health sector; steps include: 1) Coordinating select public health response functions across multiple entities; 2) Collecting, integrating, and analyzing epidemiologic, lab testing, and other data; 3) Sharing information with partners; 4) Developing and disseminating guidance, emergency risk communication messages, and other recommendation to targeted audiences or at-risk populations; 5) Coordinating the implementation of control measures such as the distribution and dispensing of appropriate medical countermeasures

Staffing

A major priority as a leader for preparing for an influx of patients or the need to evacuate

Joint Operation Center (JOC)

A regional multi-jurisdictional, interagency operations center to lead and coordinate the operational law enforcement response; led by the FBI on-scene commanders; acts as the focal point for the management and direction of on-scene law enforcement activities

Disaster

A severe event such as a massive flood, destructive tornado, or hurricane, or human-caused or terrorist attack; community-wide impact which requires outside assistance from the state or federal government; disrupts the social order, psyche, and sense of security of the area or region

Incident Command System

A standardized approach to the command, control, and coordination of emergency response incident management; has evolved to a system for all hazards and can be used in any sized incident that impacts daily operations; examples include: HAZMAT incidents, high census, and mass casualty incidents

Catastrophe

An unusually extreme, rare event that affects an entire nation or part of the world; require extensive assistance from outside the region and a global response; damage to those affected may be profound and prolonged; ex. 9/11, Haiti earthquakes, Japan tsunamis

Response

Activities occur during an emergency; one of 5 National Preparedness Goal mission areas; involves responding quickly to save lives, protect property and the environment, and meet basic human needs; involves putting your preparedness plans in action (ex. seeking shelter from a tornado)

Hospital Incident Command System (HICS)

An ICS structure specifically designed for hospitals; principles presented in the framework overlap the mission areas (prevention, protection, mitigation, response, recovery); can be used in both emergent incidents or non-emergent events; functions performed by the Hospital Incident Management Team

Public health emergency management (PHEM)

An emerging field that draws on specific sets of knowledge, techniques, and organizing principles found in the fields of emergency management and public health that are necessary for the effective management of complex health events and emergencies with serious health impacts

How to manage the media

Best practices: 1) Added security will help manage, especially when it comes to protecting pt privacy and confidentiality; most members of the media are not concerned about HIPAA, infection control, privacy, or your image; 2) Establish fair and uniform rules and scrupulously enforce them; 3) Never put yourself in an adversarial position, no matter the provocation; 4) Establish a good access for your media person, and make sure they remain fully informed so that they can maintain credibility with the media; 5) Don't let questions put words in your mouth; 6) Be the media's conscience and don't let them force the situation out of control

Great catastrophe

Classification to distinguish when a region's ability to help itself is distinctly overtaxed, making supraregional or international assistance necessary; # of fatalities exceeds 2,000, # of homeless exceeds 200,000, overall losses exceed 5% of the country's GDP, or the country is dependent on international aid

National Incident Management System

Comparison document to the National Response Plan; provides standard command and management structures that apply to response activities and a consistent nationwide template; provides the common operational concepts and basic organizational structure to ensure seamless transitions and integration of resources; ensures responders anywhere can work together regardless of the nature or location of the incident; five key components: 1) Adoption of NIMS, 2) Planning, 3) Training and exercises, 4) Communications and information management, 5) Command and control

1135 waiver

Created by Section 143 of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002; authorizes the HHS secretary to temporarily waive or modify Medicare, Medicaid, or CHIP requirements when the president declares an emergency or disaster; waivers can include conditions of participation, pre-approval requirements, state licensing, EMTALA sanctions for transfers, HIPAA noncompliance

National Association of City and County Health Officials

Criteria-based emergency preparedness program developed for local public health departments emphasizing documentation of an all-hazards preparedness plan and comprehensive exercise plan

Key findings of the HPP

Discovered by the ASPR; includes: 1) Disaster preparedness of hospitals has improved since start of HPP, 2) Emergence of healthcare coalitions is creating foundation of U.S. healthcare preparedness, 3) Planning for catastrophic emergencies still in early stages, 4) Progress requires additional national assistance and direction; 5) Most useful indicators for preparedness are: surge capacity, capability goals, assessment of training and analysis of performance during actual events or exercises, 6) HPP should focus on coalitions for a national disaster response system, 7) Admin adjustments to HPP can improve effectiveness, 8) DHHS should provide leadership to address problems in disaster standards, 9) Catastrophic emergency preparedness is a national security issue

HICS general staff

Divided into sections and led by corresponding section chiefs from operations, planning, logistics, and finance and administration

Reasons our vulnerability to disasters is increasing

Includes 1) Climate change, 2) Relocation to hazard-prone areas, 3) No financial means to avoid hazard-prone areas, 4) Rising insurance density

International Organization for Standardization-Societal Security

Establishes common understanding on the protection of society and response to incidents caused by intentional and unintentional acts

Emergency Management Accreditation Program

Establishes voluntary standards, assessment, and accreditation process for disaster preparedness programs across the nation; the gold standard of emergency management programs in the U.S.

Incident commander

Every incident will have one as part of the command staff; typically the most senior person on duty at the time of the incident and have the authority to make decisions for the org and provide direction for the HIMT; first person responding fills this role until someone with more expertise/training has arrived

Four "C"s of a successful integration for a disaster response

Includes 1) Communication, 2) Cooperation, 3) Collaboration, and 4) Coordination

5 key principles of the National Response Framework

Includes 1) Engaged partnership, 2) Tiered response, 3) Scalable, flexible, and adaptable operational capabilities, 4) Unity of effort through unified command, 5) Readiness to act

Regional Response Coordination Centers (RRCC)

FEMA has 10 regional offices and each maintains one of these; supports deployment of FEMA assets

Healthcare Preparedness and Response Capabilities

Four capabilities that describe what entities in healthcare should do to effectively prepare for and respond to emergencies

Non-Stafford Act incidents

In these situations where the federal government is involved, the president may designate a federal agency to serve as the Lead Federal Agency (LFA) for the response; the LFA will employ NIMS to coordinate the federal response

HSPD

Homeland Security Presidential Directives; #5 mandates the National Incident Management System to manage incidents; #8 requires a national all-hazards preparedness goal

HPP

Hospital Preparedness Program; sponsored by the ASPR

Recipient of preparedness funds

In order to be one, you are required to develop an incident management framework that complies with the National Incident Management System

Key influencers to staff willingness to report to work

Include: 1) The type of disaster, 2) Concern for family, 3) Concerns for personal safety, 4) Pet care needs, 5) Lack of PPE

Disaster with mass fatalties

In this type of situation, make sure that you: 1) Assign a casualty assistance officer, 2) Assign an experience chaplain as the personal representative to meet with the next of kin and care for their needs, 3) Casualties are news, and this news travels rapidly. Your timely reactions will ease the burden on the next of kin, 4) Provide for survivor needs, 5) A public memorial service where participants can share their sense of pride and loss may help survivors, 6) Assign the necessary security personnel to protect the privacy of survivors. Usually, survivors are in no condition to talk to the media, investigators, or law enforcement, 7) Coordinate and communicate with orgs and individuals who want to help- without supervision, they can create chaos, 8) Anticipate a delayed stress reaction during the aftermath- make sure medical officers and chaplains remain available

What the most effective leaders in a crisis do

Include: 1) Are visible by walking around, 2) Are calm and focused, 3) Are rested, 4) Assume nothing, 5) Communicate constantly, 6) Have a plan and know how to execute it, 7) Realize they may be unable to rely on outside help, 8) Have prepared the organization to be self-sufficient, 9) Are prepared to deal with personal challenges, 10) Are not afraid to challenge authority, 11) Define primary elements of the situation, 12) Consider major values, interests, and objectives, 12) Search for alternative courses of action, 13) Estimate costs and risks of alternatives, 14) Discriminate between relevant and irrelevant info, 15) Assess situation from other perspectives, 16) Resist defensive procrastination and premature closure, 17) Monitor feedback from the developing situation, 18) Make adjustments to make real changes in the environment

Guidelines for managing during a crisis

Include: 1) Don't make it worse, 2) Capture control of the information flow, 3) The problem is usually too much info, not too little, 4) Establish filters to help isolate you from all the input clamoring for your attention, 5) Save yourself for the main events, 6) Put problems into boxes and delegate, 7) Refuse to be drawn into trivial matters, 8) Insist helpers get adequate rest; and if you don't follow it, neither will other, 9) Make sure that everyone knows what is happening; voids are filled with rumors, 10) Select a good boss, 11) Return to normal operations ASAP, 12) Litigation may follow; keep good records and an audit trail, 13) Beware of abdicators; don't let individuals or organizations abdicate their responsibilities, 14) Know your own territory; capabilities; limitations; lines of communications; a crisis is not the time to "get to know people", 15) Critically re-examine assumptions, 16) Feed the media

Basic considerations for medical staff issues

Include: 1) It is not uncommon for medical staff to be on staff at multiple hospitals- which one can they staff?; 2) Call paid medical staff officers, medical directors, section chiefs, and other medical staff administrators to have them in house to deal with these issues; 3) Make medical command a part of the incident command center, or have the medical command center adjacent to the incident command center; 4) Make sure that your emergency and critical care centers are all covered along with radiology, lab, and anesthesia; make sure you have at least one general surgeon in house, and if you have L&D and/or a NICU at least one neonatologist in house; 5) Use your house staff to the fullest extent (residents, etc.)

6 symptoms of defective decision making in a crisis

Includes 1) Giving diminished attention to an action's long-range consequences, 2) Perceived requirement for decisional closure leading to premature action, 3) Tendency toward irrational procrastination, 4) Cognitive rigidity, 5) Tendency to reduce cognitive complexity and uncertainty, 6) Tendency to reduce the range of options considered, 7) Tendency to bolster, 8) Viewing the present in terms of the past, 9) Tendency to seek familiar patterns, 10) Diminished creativity, 11) Tendency toward the fundamental attribution bias, 12) Tendency to fall into the actor-observer discrepancy

Public health department role over the "state of catastrophic health emergencies"

Includes 1) Planning and executing the catastrophic health emergency assessment, mitigation, preparedness, response, and recovery for the state; 2) Coordinating the catastrophic health emergency response between state and local authorities, 3) Collaborating with relevant federal govt authorities, elected officials of other states, private orgs, or companies; 4) Coordinating recovery operations and mitigation initiatives, 5) Organizing public information activities

Reasons for not "getting serious" about disasters

Includes 1) Preparedness costs $, 2) Never think disasters will happen to you, 3) Lack of expertise in healthcare emergency management, 4) Business risk of preparedness, 5) Rosy assumptions from hospitals

Role of state government

Includes 1) Supplement and facilitate local efforts before, during, and after incidents, 2) When state resources are scarce or the event exceeds the state's ability to response, make a formal request for federal assistance

States with most federal disaster declarations

Includes 1) Texas, 2) California, 3) Florida, 4) Oklahoma, 5) New York, and 6) Louisiana

National Preparedness Goal

Includes five mission areas and 32 core capabilities

Local level partners

Includes public safety (local police, fire, hazmat, EMS), local school districts and higher ed, city and county DOTs, welfare and homeless services, social services agencies, local public health depts, city utility companies, local media outlets

Five factors that promote hospital preparedness

Includes: 1) Availability of funding, 2) Federal govt focus and guidance, 3) Standards and regulations, 4) Experience with or examples of adverse outcomes from inadequate prep, 5) Community standards for supporting local hospitals

Benefits of using HICS

Includes: flexibility and adaptability to meet specific needs and capabilities of hospitals (can staff anywhere from 1-70 positions as needed); customizable; component of an Emergency Operations Plan; efficient response; integration with community; federal preparedness and response grant compliant; accreditation compliance; resource management

Preparation

Involves having enough supplies to last for 3-5 days on your own, having your generators topped off to run continuously for 3 days or longer, and having a backup plan in place to get additional diesel on demand

Fire

Kills more Americans than any other cause, when medical causes of death are eliminated

Planning section chief

Leader in an incident responsible for: developing plans for incident documentation, tracking the status of all resources given to the incident, gathering, evaluating, and disseminating situational awareness info, developing tactics for demobilization, and preparing the Incident Action Plan and leading the briefing; wears a blue vest

Operations section chief

Leader in an incident responsible for: implementing tactics based on incident objectives, organizing, allocating, and directing the strategic resources, managing the staging area, and determining the need to assign resources to support mission objectives; wears a red vest

Finance and administration section chief

Leader in an incident responsible for: monitoring personnel time, negotiating and monitoring any necessary contracts, analyzing costs, and completing necessary reimbursement documentation related to compensation for injury and damage to property/fatalities; wears a green vest

Unity of command

Means that every individual has a designated supervisor to whom he or she reports when managing the incident; ex. each nurse has a single supervisor the report to in an incident

Security issues

Must be prepared for the following: 1) Sometimes employees and their families or general members of the community may flock to the hospital out of the perception that the hospital is a secure place, sturdily built, with emergency power and plenty of food, etc.; 2) It may be necessary to limit access to your building down to 1 or 2 entrances/exits, 3) Those approved to enter/exit will be ID by their security badges; bring in extra security and have a lockdown plan completed in advance

ASPR

Office of the Secretary for Preparedness and Response; sponsors and has charge of the Hospital Preparedness Program; falls under the purview of the U.S. Department of Health and Human Services

Prevention

One of 5 National Preparedness Goal mission areas; involves preventing, avoiding, stopping an imminent, threatened, or actual act of terrorism

Protection

One of 5 National Preparedness Goal mission areas; involves protecting citizens, residents, visitors, and assets against greatest threats and hazards in a manner that allows our interests, aspirations, and way of life to thrive

Paranoid personality

One of the three common aberrant personalities; feels surrounded by enemies and is extremely suspicious of the motivations of others; has trouble trusting others

Compulsive leader

One of the three common aberrant personalities; often becomes paralyzed by indecision and tends toward irrational procrastination for fear of making a mistake- most comfortable applying set policies and procedures to solve problems; sensitive to the leadership hierarchy, overly response to superiors, competes with peers

Stafford Act

Passed in 1988, gives president power to declare a national emergency as a response to a national disaster and access funds and disaster relief assistance set aside by Congress; two levels: 1) "Emergency declaration"- more limited in scope, 2) "Major disaster declaration"- provides more federal programs

National Security Council (NSC)

Principal policy body for consideration of national security policy issues requiring presidential determination; advices and assists the president in integrating all aspects of national security policy as it affects the U.S. (domestic, foreign, military, intelligence, economic)

WHO Framework for a Public Health Emergency Operations Center

Recently published guidance by WHO for use by ministries of health and other health authorities outlining "key concepts and essential requirements for developing and managing a PHEOC for the purpose of enabling a goal-oriented response to public health emergencies"

Chain of command

Refers to the orderly line of authority within the ranks of the incident management structure

Common terminology

Required by the Incident Command System so all agencies have the ability to collaborate; goal is to ensure efficient, clear communication among all parties involved in managing an incident

CMS

Requires organizations to develop emergency plans, communications, training plans, policies, and procedures; implementation of exercises to receive Medicare and Medicaid $

Failure to coordinate distribution of supplies

The cause of most logistics problems faced during many U.S. disasters

285

The number of great catastrophes since 1950

Miami

The one U.S. city on. the list of 10 cities accounting for 50% of the worldwide exposure to coastal flooding and high winds

Preston v. Tenet Health System- Memorial Medical Center

The outcome of the court case was that Tenet settled for 45 preventable deaths that occurred in the hospital during Hurricane Katrina following the levy breaking